Conjunctivitis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Conjunctivitis is the most common eye infection causing dilation of conjunctival blood vessels and results in inflammation. The most common cause of conjunctivitis is infection of which viral infections are the commonest cause, followed by bacterial. The non-infection forms are allergic, mechanical, toxic and neoplastic. Among noninfectious conjunctivitis, the allergic form is more common. Infectious conjunctivitis can be presented with red eye, foreign body sensation, itching, light sensitivity, burning, and watery discharge in viral conjunctivitis and mucopurulent discharge in bacterial form. Regarding the onset and severity of clinical symptoms, conjunctivitis is classified as acute, chronic, and recurrent. Most cases of infectious conjunctivitis are considered as acute conjunctivitis. Allergic conjunctivitis can be chronic while it can be present with acute exacerbations related to seasonal factors or contact lens use. It is important to differentiate conjunctivitis from other sight-threatening eye diseases that have similar clinical presentation.

Causes

Life Threatening Causes

Most cases of conjunctivitis are relatively mild and will not cause eye damage of any sort. However, if it left untreated it can lead to sight-treathening complications including:[1]

Viral conjunctivitis

Bacterial conjunctivitis

Diagnosis

Some initial diagnosis should be excluded for which physicians should manage patients by a systematic approach.[4]

 
 
 
 
 
 
 
 
Suspected acute conjunctivitis
(<4 weeks duration)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Associated with pain, blurred vision, photophobia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
 
Any discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Itiching
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ophthalmology referral
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Differential diagnosis

Differentail diagnosis Manifestation Examination findings
Blepharitis[5] Burning and foreign-body sensation, symptoms worse with prolonged reading or watching Bilateral redness
Uveitis[6] Photophobia, pain, blurred vision Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, red eye
Angle closure glaucoma[7] Headache, nausea, vomiting, ocular pain, decreased vision, light sensitivity Firm eye on palpation, ocular redness, steamy cornea
Endophthalmitis[8] Severe pain, photophobia Red eye, pus in the anterior chamber, history of eye surgery or ocular trauma
Scleritis[9] Decreased vision, moderate to severe pain Redness, bluish sclera
Subconjunctival hemorrhage[10] foreign-body sensation and tearing or be asymptomatic Blood under the conjunctival membrane

Treatment

Medical therapy for conjunctivitis
Category Epidemiology Type of discharge Cause Treatment
Viral conjunctivitis 80% of all acute conjunctivitis Serous Adenovirus in 65% of cases Cold compress

Artificial tears Antihistamines

HSV 1.3-4.8 of all acute conjunctivitis Variable Herpes simplex virus Topical acyclovir 1 drop 9 ×/d for 7-10 days
Acute bacterial conjunctivitis 18.3%-57% of all acute conjunctivitis Mucopurulent S aureus, S epidermidis, H influenzae

S pneumoniae

Aminoglycosides

Ointment: 4 ×/d for 1 wk Solution: 1-2 drops 4 ×/d for 1 wk
Fluoroquinolones

ointment: 3 ×/d for 1 wk Solution: 1-2 drops 4 ×/d for 1 w

Allergic conjunctivitis Up to 40% of population may be affected Serous or mucoid Pollens Topical antihistamines

Topical mast cell inhibitors

Do's

Don'ts

  • People with weaker immune systems such as those with diabetes and people who don’t wash their hands before inserting or removing contact lenses are more at risk of bacterial conjunctivitis.[13]
  • Patients with any form of conjunctivitis should refrain wearing contact lenses until the conjunctivitis has completely cleared up.
  • Both types of infectious conjunctivitis are very contagious and easily spread. It is important to avoid contacting with other or sharing equipments with other people to help prevent spreading the infection.

References

  1. Epling J (2012). "Bacterial conjunctivitis". BMJ Clin Evid. 2012. PMC 3635545. PMID 22348418.
  2. Yeu E, Hauswirth S (2020). "A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management". Clin Ophthalmol. 14: 805–813. doi:10.2147/OPTH.S236571. PMC 7075432 Check |pmc= value (help). PMID 32210533 Check |pmid= value (help).
  3. Azari AA, Arabi A (2020). "Conjunctivitis: A Systematic Review". J Ophthalmic Vis Res. 15 (3): 372–395. doi:10.18502/jovr.v15i3.7456. PMC 7431717 Check |pmc= value (help). PMID 32864068 Check |pmid= value (help).
  4. Varu, Divya M.; Rhee, Michelle K.; Akpek, Esen K.; Amescua, Guillermo; Farid, Marjan; Garcia-Ferrer, Francisco J.; Lin, Amy; Musch, David C.; Mah, Francis S.; Dunn, Steven P. (2019). "Conjunctivitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P94–P169. doi:10.1016/j.ophtha.2018.10.020. ISSN 0161-6420.
  5. Amescua, Guillermo; Akpek, Esen K.; Farid, Marjan; Garcia-Ferrer, Francisco J.; Lin, Amy; Rhee, Michelle K.; Varu, Divya M.; Musch, David C.; Dunn, Steven P.; Mah, Francis S. (2019). "Blepharitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P56–P93. doi:10.1016/j.ophtha.2018.10.019. ISSN 0161-6420.
  6. Harthan JS, Opitz DL, Fromstein SR, Morettin CE (2016). "Diagnosis and treatment of anterior uveitis: optometric management". Clin Optom (Auckl). 8: 23–35. doi:10.2147/OPTO.S72079. PMC 6095364. PMID 30214346.
  7. Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
  8. Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS (2002). "Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions". Clin Microbiol Rev. 15 (1): 111–24. doi:10.1128/cmr.15.1.111-124.2002. PMC 118063. PMID 11781270.
  9. Al Barqi M, Behrens A, Alfawaz AM (2015). "Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia". Int J Ophthalmol. 8 (6): 1215–9. doi:10.3980/j.issn.2222-3959.2015.06.25. PMC 4651892. PMID 26682176.
  10. Tarlan B, Kiratli H (2013). "Subconjunctival hemorrhage: risk factors and potential indicators". Clin Ophthalmol. 7: 1163–70. doi:10.2147/OPTH.S35062. PMC 3702240. PMID 23843690.
  11. Owen CG, Shah A, Henshaw K, Smeeth L, Sheikh A (2004). "Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness". Br J Gen Pract. 54 (503): 451–6. PMC 1266207. PMID 15186569.
  12. Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  13. Tarabishy AB, Jeng BH (2008). "Bacterial conjunctivitis: a review for internists". Cleve Clin J Med. 75 (7): 507–12. doi:10.3949/ccjm.75.7.507. PMID 18646586.


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